Healthcare Provider Details

I. General information

NPI: 1891469805
Provider Name (Legal Business Name): SEAN B HORNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CALLE MEDICO STE H
SANTA FE NM
87505-4828
US

IV. Provider business mailing address

928 LOS LOVATOS RD
SANTA FE NM
87501-1248
US

V. Phone/Fax

Practice location:
  • Phone: 303-519-4816
  • Fax:
Mailing address:
  • Phone: 303-519-4816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT5499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: